IRs-in-training column

With the advent of the new IR training paradigm, those currently in their second year of residency (R2s) will be the last class able to complete a traditional one-year IR fellowship after graduating from a diagnostic radiology (DR) residency. Starting July 1, 2020, the independent IR residency will be implemented, wherein graduates of a DR residency who do not complete an Early Specialization in Interventional Radiology (ESIR) will be required to complete a two-year independent IR residency to obtain certification in both IR and DR.

However, current R1s and interns (in the academic year 2016–17) now have the option to transfer internally into an integrated IR program if their training institution has an approved integrated program. Such programs will be looking to backfill from the existing DR residents at their institution.

Another option for those who graduate June 30, 2020, and beyond is ESIR. DR programs with an ESIR track, in which the resident will be able to complete 12 months of IR/IR-related rotations during their DR residency, will allow for advanced placement into the second year of an independent IR residency, effectively shortening the post-DR residency training into 1 year of independent IR residency.

Recently, the SIR Resident, Fellow and Student Section (RFS) hosted a webinar for senior medical students and current DR residents who are interested in learning the details of transferring from DR to IR. The following Q&A summarizes the discussion between program directors and more than 70 medical student and resident attendees.

What kind of difficulties (if any) did you experience as you established a DR to IR transfer process?

Transfer is multifaceted and involves coordination between the DR and IR program directors, American Board of Radiology (ABR), Residency Review Committee (RRC) and local graduate medical education (GME) office. In addition, developing the evaluation tools for the new IR residency, which includes set-up of the program evaluation committee and clinical competency committee, is a challenge. But perhaps the biggest challenge is the culture change as all current IR attendings are graduates of the traditional fellowship model and might therefore be less familiar with the new residency model.

What key factors will you consider when evaluating a DR resident for transfer?

Technically skilled and clinically oriented residents are desired in IR. However, overall performance on DR rotations—not just IR rotations—are important. IR program directors may look for guidance from DR program directors on how a candidate performed in the various subspecialties of DR. Along the same vein, improvement in the resident’s yearly ABR in-service exam is preferred. Medical school grades and U.S. Medical Licensing Examination (USMLE) scores will be of little value. Involvement in extracurricular activities related to IR such as research, QI projects, involvement in the SIR RFS and your institution’s IR interest group will help.

What are the advantages and disadvantages of transferring into the IR residency?

Transferring into IR residency is designed for residents who are sure of a career in IR. For those, it is advantageous in that they establish an identity early in their IR training. Residents who would like to keep their options open are encouraged to consider ESIR and independent IR residency. Graduates of the independent IR residency are no less desirable than those of the integrated IR residency.

Would it be beneficial for residents graduating from a DR residency June 30, 2019 (the last class eligible to complete a traditional 1-year fellowship) to transfer to an institution with an integrated IR residency?

Currently, residents are not able to transfer externally from an outside DR residency to an integrated IR residency.

How would current fourth-year medical students be viewed at their DR residency interview if they express an interest in transferring internally to the IR residency?

Fourth-year medical students are encouraged to voice interest in IR. It should not negatively impact their chances to match at a DR residency with an integrated IR residency.

Will you prefer or require transfers to have any specific PGY-1 training (i.e., transitional year vs. IM vs. surgery)?

No. The type of internship year should have no bearing on your ability to later transfer from a DR to an integrated IR residency.

In which years will you be accepting internal transfers from DR to IR integrated residency?

Transfers into or out of the integrated program can occur at any time through the end of the R3 year. In terms of training, an integrated IR residency is essentially identical to a DR residency through R1–3 year at most institutions (there are some institutions with slight variation in curriculum).

Do you plan to eventually stop accepting transfers? If not, how many positions do you plan to reserve for your local DR residents? For which years and how many positions?

Transfers will only be possible if a spot in the integrated IR program is vacant due to transfer or a spot goes unfilled. The advantage of internal transfer from an IR program director’s point of view is that he or she will be more familiar with the resident’s ability to succeed in their IR residency.